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<blockquote data-quote="Ricochet1a" data-source="post: 1173360" data-attributes="member: 22880"><p>Replying to myself since I received more information...</p><p></p><p></p><p></p><p>I received an email with a PDF of the employee handout that was dated July 9th (you should have access to this), that gives some more details. </p><p></p><p>The two plans will be called "Consumer Choice" and "Consumer Premier". There was no mention of the 'low option' which used to cost the employee next to nothing for catastrophic coverage only (it looks like the Consumer Choice plan is a catastrophic plan only). </p><p></p><p>The breakdowns are as follows:</p><p></p><p>"Choice": $2,250 deductible for employee only, $4,500 for family. Covers 70% of in-network costs after deductible - has annual maximum out of pocket maximum (not in doc). Deductible doesn't apply to PCP visits or Rx drugs. In-network PCP has 30% co-insurance unless visit is for 'preventive care' (I thought all medical care was intended to 'prevent' death or diminished quality of life...), preventive care is 100% covered. In-network specialists are 30% coinsurance AFTER deductible has been met (I'm left a bit confused by the wording in the doc, it appears specialist are covered ENTIRELY by the insured (you) until you hit your deductible), THEN the 30% coinsurance kicks in. If this is the case, going to a non-PCP for anything will be quite costly under this plan...</p><p></p><p>"Premier": $1,200 deductible for employee only, $3,600 for family. Covers 80% of in-network costs after deductible - has annual maximum out of pocket maximum (not in doc). deductible doesn't apply to PCP visits or Rx drugs. In-network PCP has 20% co-insurance unless visit is for 'preventive care', which is 100% covered. Specialists have a 20% coinsurance after the deductible has been met. Again, it looks like going to a specialist requires the covered to pay the whole amount until their annual deductible has been met - then the 20% coinsurance kicks in. </p><p></p><p>Copayments for office visits are gone. If PCP, then the coinsurance applies, if specialist, then 'insured' pays full amount until annual deductible has been met - then coinsurance kicks in. </p><p></p><p>What this is doing, is effectively taking away the option for most to go to a specialist - or if they do decide to seek a specialist (even with a 'referral', the covered will pay through the nose until the annual deductible has been covered. </p><p></p><p>The 'smiley face' that they are going to slap on this pile of crap will be the "Health Reimbursement Account". </p><p></p><p>It looks for both options, Fred will 'place' $400 into this account for employee only, $650 for employee+children and $800 for employee+family. These funds can be used to 'pay for qualifying medical expenses'. "If unused, the balance will roll over to the next year as long as you remain enrolled in coverage". So I'm assuming if you drop coverage (or quit) any unused amount goes back to Fred (absolutely no mention of funds rolling into retirement accounts as I've heard). </p><p></p><p>The HRA is merely a smoke screen. If they REALLY wanted to, they could do away with the HRA and merely reduce your annual insurance premiums by the amounts listed above for the coverage options (reduced paperwork, administrative costs, etc.). They don't want to do this, since they want to control that money and if for whatever reason an employee doesn't use it, the cash goes back to Fred upon the employee's quitting. Use it or lose it... Unless someone has something different, this has to be the assumption. </p><p></p><p>No mention of monthly premiums in the document. </p><p></p><p>After looking at these breakdowns, the end effect (compared to current) on the employees WILL VARY based upon the employee's age, health and the age and health of family covered with the employee. </p><p></p><p>Employees in their 20's ought to come out about even to current plans IF they are healthy with no family members with chronic conditions. The HRA should cover the occasional office visit, so this employee will more or less break even. </p><p></p><p>Employees in their 30's or those with a family member with some chronic (but easily manageable condition), will lose slightly. They will quickly use up the HRA cash, and 3-4 visits to a specialist in a year will completely deplete that even WITHOUT any diagnostic tests or office procedures. </p><p></p><p>Employees in their 40's lose with this plan. They will quickly use up the HRA amount on occasional office visits and with a single 'emergent' condition (kidney stone, strained back, sprained ankle, etc.). If this employee (or covered family member) sees a specialist regularly, they will LOSE even more under this plan. I think the deductible for the Premier option is $1,500 annually for those with family plan currently. With the jump to $3,600 deductible (subtracting the $800 HRA), the net deductible is $2,800 a year, $1,300 MORE than current. This comes straight out of this employee's pocket. No smiley face can be put on this (unless the employee is truly stupid - they do exist in Express...). Since specialists aren't covered by coinsurance until the deductible is met in full (that is how I'm reading it), those who use a specialist as their de facto PCP are going to pay big for this change. I'm sure this is INTENDED - to get employees to go back to PCPs for primary care and only see specialists for their 'speciality'. My parents use their particular specialists as their de facto PCP and I know many others do to. </p><p></p><p>So the days of paying just a little extra to see a specialist of your choice are over. You can see one, but you'll foot the entire bill (covered by any HRA cash until that runs out). This is all part of the smoke screen- Express can tell you one thing while keeping a straight face, while the reality is something completely different, classic FedEx in motion. </p><p></p><p>Employees in their 50's are going to take it in their shorts (I'm seeing a deliberate pattern on the part of FedEx to get rid of ALL employees in their 50s, both hourly and salaried....).</p><p></p><p>Many employees in this age cohort have existing chronic medical conditions. They use their insurance and their PCP or specialist of choice knows them by name and recognizes them without looking at a medical chart. They average $2,000 to $4,000 a year in medical billings (assuming nothing serious goes wrong), and if they do have something come up, are easily looking at $5,000 to $10,000 in billings for a few days of inpatient care, diagnostics and physician referrals (most will be out-of-network). Many of these employees will have a spouse that has medical condition that requires even more in health care utilization. These people will max out their deductible in most years AND will be battling the 'in-network' versus 'out-of-network" games that go on. Many quality providers DON'T agree to the rates offered to get in-network coverage, so they are by default (if they treat you), out-of-network. </p><p></p><p>Out-of-network ends up costing you THROUGH THE NOSE, since the insurance will only pay a percentage of THEIR in-network rate. YOU as a patient, are legally bound to cover the remainder not covered by the insurance to the out-of-network provider.</p><p></p><p>For example... if your family is treated and have a total $10,000 billing in a year, with $4,000 of that provided by in-network providers and the other $6,000 by out-of-network providers (this happens more than you think). Here's how it would break down (assuming you haven't 'gone to the doctor' for anything else that year and are on Premier).</p><p></p><p>In-network would be broken up between deductible and non-deductible amounts. You'd be responsible for $3,600, that would be off-set by the $800 HRA cash, then co-insurance would kick in. Your in-network responsibility would be $2,800 + $80 = $2,880. </p><p></p><p>Then the fun really starts... the out-of-network.</p><p></p><p>Your deductible would be met, BUT, the amounts billed by out-of-network providers and what is 'allowed' are two different things - they usually differ by about 3 times. So of this $6,000 billed by out-of-network providers, your insurance may only agree that about $2,000 of that is 'usual and customary charges'. So what they do is to pay the insured amount for that $2,000 (a percentage of that, based on your coinsurance), then YOU are personally responsible for any difference to the provider (and they will take you to collections for non-payment). </p><p></p><p>Let's assume (have to make assumptions...), that Anthem or CIGNA agrees to pay $2,000 for the out-of-network providers, you are left with the other $4,000 due and payable. So with a "$10,000 billing", you are paying just under $7,000 for that year (and you thought you had insurance...). </p><p></p><p>All smoke and mirrors. The 'real game' is fewer and fewer providers are accepting the low-ball rates to be considered in-network for these crummy plans. If they were to accept these rates, then the OTHER insurance plans that agree to a higher 'usual and customary fee' would want the same reimbursement rates. So the low ball insurance has very few in-network providers. You have the illusion that you have insurance, but when something really happens and you use it, you will learn real quick just how important the distinction between in and out of network really is. The kicker is that once you sign an admission form to a hospital or clinic, YOU become the final responsible party for all billing. This means that if an out-of-network provider does something for you, to you or with you, you are stuck paying whatever you thought your insurance would pay - and DIDN'T. </p><p></p><p>They have a 1-800 number for the employees to call with questions. </p><p></p><p>1-800-888-5622</p><p></p><p>7AM to 7PM Monday through Friday - so you'd better call right after work or on your break....</p><p></p><p>I'd suggest that you call early and often. I'm sure the scripted answers they will give will be most informative and satisfying. Have fun. </p><p></p><p>Oh by the way, do one of three things: get your fellow employees to start signing those damn union cards, OR learn to love Fred OR start making serious plans to get the hell out....</p></blockquote><p></p>
[QUOTE="Ricochet1a, post: 1173360, member: 22880"] Replying to myself since I received more information... I received an email with a PDF of the employee handout that was dated July 9th (you should have access to this), that gives some more details. The two plans will be called "Consumer Choice" and "Consumer Premier". There was no mention of the 'low option' which used to cost the employee next to nothing for catastrophic coverage only (it looks like the Consumer Choice plan is a catastrophic plan only). The breakdowns are as follows: "Choice": $2,250 deductible for employee only, $4,500 for family. Covers 70% of in-network costs after deductible - has annual maximum out of pocket maximum (not in doc). Deductible doesn't apply to PCP visits or Rx drugs. In-network PCP has 30% co-insurance unless visit is for 'preventive care' (I thought all medical care was intended to 'prevent' death or diminished quality of life...), preventive care is 100% covered. In-network specialists are 30% coinsurance AFTER deductible has been met (I'm left a bit confused by the wording in the doc, it appears specialist are covered ENTIRELY by the insured (you) until you hit your deductible), THEN the 30% coinsurance kicks in. If this is the case, going to a non-PCP for anything will be quite costly under this plan... "Premier": $1,200 deductible for employee only, $3,600 for family. Covers 80% of in-network costs after deductible - has annual maximum out of pocket maximum (not in doc). deductible doesn't apply to PCP visits or Rx drugs. In-network PCP has 20% co-insurance unless visit is for 'preventive care', which is 100% covered. Specialists have a 20% coinsurance after the deductible has been met. Again, it looks like going to a specialist requires the covered to pay the whole amount until their annual deductible has been met - then the 20% coinsurance kicks in. Copayments for office visits are gone. If PCP, then the coinsurance applies, if specialist, then 'insured' pays full amount until annual deductible has been met - then coinsurance kicks in. What this is doing, is effectively taking away the option for most to go to a specialist - or if they do decide to seek a specialist (even with a 'referral', the covered will pay through the nose until the annual deductible has been covered. The 'smiley face' that they are going to slap on this pile of crap will be the "Health Reimbursement Account". It looks for both options, Fred will 'place' $400 into this account for employee only, $650 for employee+children and $800 for employee+family. These funds can be used to 'pay for qualifying medical expenses'. "If unused, the balance will roll over to the next year as long as you remain enrolled in coverage". So I'm assuming if you drop coverage (or quit) any unused amount goes back to Fred (absolutely no mention of funds rolling into retirement accounts as I've heard). The HRA is merely a smoke screen. If they REALLY wanted to, they could do away with the HRA and merely reduce your annual insurance premiums by the amounts listed above for the coverage options (reduced paperwork, administrative costs, etc.). They don't want to do this, since they want to control that money and if for whatever reason an employee doesn't use it, the cash goes back to Fred upon the employee's quitting. Use it or lose it... Unless someone has something different, this has to be the assumption. No mention of monthly premiums in the document. After looking at these breakdowns, the end effect (compared to current) on the employees WILL VARY based upon the employee's age, health and the age and health of family covered with the employee. Employees in their 20's ought to come out about even to current plans IF they are healthy with no family members with chronic conditions. The HRA should cover the occasional office visit, so this employee will more or less break even. Employees in their 30's or those with a family member with some chronic (but easily manageable condition), will lose slightly. They will quickly use up the HRA cash, and 3-4 visits to a specialist in a year will completely deplete that even WITHOUT any diagnostic tests or office procedures. Employees in their 40's lose with this plan. They will quickly use up the HRA amount on occasional office visits and with a single 'emergent' condition (kidney stone, strained back, sprained ankle, etc.). If this employee (or covered family member) sees a specialist regularly, they will LOSE even more under this plan. I think the deductible for the Premier option is $1,500 annually for those with family plan currently. With the jump to $3,600 deductible (subtracting the $800 HRA), the net deductible is $2,800 a year, $1,300 MORE than current. This comes straight out of this employee's pocket. No smiley face can be put on this (unless the employee is truly stupid - they do exist in Express...). Since specialists aren't covered by coinsurance until the deductible is met in full (that is how I'm reading it), those who use a specialist as their de facto PCP are going to pay big for this change. I'm sure this is INTENDED - to get employees to go back to PCPs for primary care and only see specialists for their 'speciality'. My parents use their particular specialists as their de facto PCP and I know many others do to. So the days of paying just a little extra to see a specialist of your choice are over. You can see one, but you'll foot the entire bill (covered by any HRA cash until that runs out). This is all part of the smoke screen- Express can tell you one thing while keeping a straight face, while the reality is something completely different, classic FedEx in motion. Employees in their 50's are going to take it in their shorts (I'm seeing a deliberate pattern on the part of FedEx to get rid of ALL employees in their 50s, both hourly and salaried....). Many employees in this age cohort have existing chronic medical conditions. They use their insurance and their PCP or specialist of choice knows them by name and recognizes them without looking at a medical chart. They average $2,000 to $4,000 a year in medical billings (assuming nothing serious goes wrong), and if they do have something come up, are easily looking at $5,000 to $10,000 in billings for a few days of inpatient care, diagnostics and physician referrals (most will be out-of-network). Many of these employees will have a spouse that has medical condition that requires even more in health care utilization. These people will max out their deductible in most years AND will be battling the 'in-network' versus 'out-of-network" games that go on. Many quality providers DON'T agree to the rates offered to get in-network coverage, so they are by default (if they treat you), out-of-network. Out-of-network ends up costing you THROUGH THE NOSE, since the insurance will only pay a percentage of THEIR in-network rate. YOU as a patient, are legally bound to cover the remainder not covered by the insurance to the out-of-network provider. For example... if your family is treated and have a total $10,000 billing in a year, with $4,000 of that provided by in-network providers and the other $6,000 by out-of-network providers (this happens more than you think). Here's how it would break down (assuming you haven't 'gone to the doctor' for anything else that year and are on Premier). In-network would be broken up between deductible and non-deductible amounts. You'd be responsible for $3,600, that would be off-set by the $800 HRA cash, then co-insurance would kick in. Your in-network responsibility would be $2,800 + $80 = $2,880. Then the fun really starts... the out-of-network. Your deductible would be met, BUT, the amounts billed by out-of-network providers and what is 'allowed' are two different things - they usually differ by about 3 times. So of this $6,000 billed by out-of-network providers, your insurance may only agree that about $2,000 of that is 'usual and customary charges'. So what they do is to pay the insured amount for that $2,000 (a percentage of that, based on your coinsurance), then YOU are personally responsible for any difference to the provider (and they will take you to collections for non-payment). Let's assume (have to make assumptions...), that Anthem or CIGNA agrees to pay $2,000 for the out-of-network providers, you are left with the other $4,000 due and payable. So with a "$10,000 billing", you are paying just under $7,000 for that year (and you thought you had insurance...). All smoke and mirrors. The 'real game' is fewer and fewer providers are accepting the low-ball rates to be considered in-network for these crummy plans. If they were to accept these rates, then the OTHER insurance plans that agree to a higher 'usual and customary fee' would want the same reimbursement rates. So the low ball insurance has very few in-network providers. You have the illusion that you have insurance, but when something really happens and you use it, you will learn real quick just how important the distinction between in and out of network really is. The kicker is that once you sign an admission form to a hospital or clinic, YOU become the final responsible party for all billing. This means that if an out-of-network provider does something for you, to you or with you, you are stuck paying whatever you thought your insurance would pay - and DIDN'T. They have a 1-800 number for the employees to call with questions. 1-800-888-5622 7AM to 7PM Monday through Friday - so you'd better call right after work or on your break.... I'd suggest that you call early and often. I'm sure the scripted answers they will give will be most informative and satisfying. Have fun. Oh by the way, do one of three things: get your fellow employees to start signing those damn union cards, OR learn to love Fred OR start making serious plans to get the hell out.... [/QUOTE]
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